POS0744 SYSTEMIC LUPUS ERYTHEMATOSUS WITH ACTIVE MUSCULOSKELETAL SYMPTOMS: PATIENT REPORTED SYMPTOM IMPACT, TREATMENT PATTERNS AND SATISFACTION WITH CURRENT THERAPY OPTIONS
Authors: D. L. Kamen, J. Birt, M. Hadi, E. Gibbons, D. Bushnell, R. Yu, L. Delbecque, K. Griffing, A. Askanase
Journal: Annals of the Rheumatic Diseases (2022)

Background Musculoskeletal (MSK) symptoms affect 50-95% of patients with SLE over their disease course negatively impacting functioning, and quality of life (QoL).1 In SLE-UPDATE, a US, cross-sectional, non-interventional online survey of adults with SLE, over half of the participants reported active MSK symptoms, including pain or swelling in the joints (53%) and stiffness (57%).2 The present study evaluated the sub-group of participants with ‘currently active’ MSK symptoms. Objectives To describe the self-reported disease burden, treatment patterns, and satisfaction with therapies in patients with SLE, comparing those with versus without active MSK symptoms. Methods This secondary analysis of SLE-UPDATE survey data stratified participants into active or non-active MSK group. Participants currently experiencing pain or swelling and/or stiffness in their joints and had a Joint Pain NRS &gt; 4 were in the “active MSK group”. All remaining participants were in the “non-active MSK group”. Analysis comprised descriptive statistics, mean (standard deviation [SD]) for continuous variables, and frequency (percentage [%]) for categorical variables. Two-sample t-test to compare mean scores and chi-squared testing to compare proportions were used. Results Of the survey participants, 285 were in the active MSK group and 215 in the non-active MSK group. The active MSK group was older (44.3 vs. 40.2 years, &lt;0.001) and had a longer time since diagnosis (12.6 vs. 9.2 years, &lt;0.001). More people in the MSK group had fibromyalgia (FM) (45 vs 12%, &lt;0.0001), worse pain, fatigue, and QoL (Table 1) suggestive of Type 2 non-inflammatory SLE symptoms. Fewer in the MSK group were employed full-time (36.5 vs. 62.8%) and more were on permanent disability (27.0 vs. 6.5%). More participants in the active MSK group negatively assessed their general health (fair or poor) over the last month (53.4 vs. 20.4%). The active MSK group self-reported more “flares” over the prior 3 months; with 44.9 vs 41.9% reporting 1-3 flares, 15.1 vs 5.1% reporting 4-6 flares, and 8.1 vs 2.3% reporting &gt; 7 flares. Table 1. Patient Reported Outcomes Active MSK Non-Active MSK FM Non-FM FM Non-FM N=129 N=156 N=26 N=189 Worst Pain NRS, Mean (SD ) 6.5 (1.7)* 4.8 (2.6) 6.9 (1.6)* 6.2 (1.8) 4.0 (2.2) 4.9 (2.6)~ Worst Joint Pain NRS, Mean (SD ) 6.7 (1.7)* 4.5 (2.6) 7.1 (1.6)* 6.5 (1.6) 3.5 (2.0) 4.6 (2.6)* FACIT Fatigue Score, Mean (SD ) 19.1 (10.8)* 28.1 (11.6) 15.4 (9.5)* 22.1 (10.9) 25.7 (13.8) 28.4 (11.3)~ LupusPRO HRQoL Score (SD ) 48.9 (20.2)* 64.1 (23.0) 45.5 (18.1)* 51.7 (21.4) 63.0 (23.9) 64.3 (22.9)~ NRS: 0 (none)-10 (worst imaginable); FACIT Fatigue: 0-52, higher= less fatigue; LupusPRO: 0-100, higher= better QoL; *p &lt; 0.05; ~ Not significant The active MSK group used more anti-malarials (50.9 vs. 30.7%), immunosuppressants (37.2 vs. 26.5%), including methotrexate (12.6 vs 3.3%), narcotic analgesics (18.6 vs. 10.2%), and topicals for joint pain (30.5 vs. 10.2%). Interestingly, treatment goals of greatest importance in both groups were reduction in fatigue and pain, but pain reduction had higher importance in active MSK group (rated very important by 26.7 vs. 18.1%). Lower proportions in the active MSK group were satisfied with steroids (58.0 vs. 77.8% &lt;0.01), immunosuppressants (65.1 vs. 80.7% &lt;0.05), methotrexate (47.2 vs. 85.7% =0.061), and belimumab (80 vs. 95.5%=0.102). Conclusion Reduction of pain and fatigue was the main treatment goal of patients with SLE whether they had active or non-active MSK symptoms. Patients with active MSK symptoms had higher pain and fatigue, lower QoL, and less satisfaction with current therapies compared to SLE patients without active MSK symptoms, driven only in part by co-morbid FM. Findings from these analyses suggest there are unmet needs to better understand MSK manifestations, their overlap with Type 2 SLE symptoms, align patient/physician priorities, and improve therapies for MSK symptoms for patients with SLE. References [1]Mahmoud K. Curr Opin Rheumatol 2017;29:486-492 [2]Birt J. Rheum Ther 2021;8:1189-1205 Acknowledgements The authors would like to thank the Lupus Foundation of America for their support with the design of the survey. Disclosure of Interests Diane L Kamen: None declared, Julie Birt Shareholder of: Shareholder of Eli Lilly &amp; Company, Employee of: Employee of Eli Lilly &amp; Company, Monica Hadi Grant/research support from: Evidera received funding to conduct this research, Elizabeth Gibbons Grant/research support from: Evidera received funding to conduct this research, Don Bushnell Grant/research support from: Evidera has received funding for the conduct of this research, Ren Yu Grant/research support from: Evidera has received funding to conduct this research, Laure Delbecque Shareholder of: Shareholder of Eli Lilly, Employee of: Employee of Eli Lilly, Kirstin Griffing Shareholder of: Eli Lilly &amp; Company shareholder, Employee of: Eli Lilly &amp; Company paid employee, Anca Askanase Grant/research support from: Investigator for GSK, AZ, Pfizer, Idorsia, Eli Lilly